Revitalize Regenerative Orthopedics LLC

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

Legal business name

REVITALIZE REGENERATIVE ORTHOPEDICS LLC

Practice address

5161 E Arapahoe Rd Ste 250
Centennial, CO 80122-4810

Phone

(720) 463-0567

NPI assigned

Sep 27, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin William O'Donnell, DONPI 1114911492

Title

Owner

Phone

(720) 463-0567

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin William O'Donnell, DO

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Centennial, CO
  • NPI 1114911492
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1727395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727395200000",
    "number": "1245058304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5161 E ARAPAHOE RD STE 250",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801224810",
            "telephone_number": "720-463-0567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5161 E ARAPAHOE RD STE 250",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801224810",
            "telephone_number": "720-463-0567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE REGENERATIVE ORTHOPEDICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-27",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A",
        "authorized_official_last_name": "O'DONNELL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "720-463-0567",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Podiatric Clinic/Center in Centennial, CO
• Providers in Centennial, CO by specialty
• Podiatric Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.